Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $346.74 / $707.95	Facility		$60.26	$346.74	$707.95
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $12.30 / $33.88	Facility	26	$7.08	$12.30	$33.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.54 / $131.83 / $831.76	Facility	TC	$27.54	$131.83	$831.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $34.67 / $100.00	Professional		$8.71	$34.67	$100.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $15.14 / $42.66	Professional	26	$7.76	$15.14	$42.66
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.20 / $83.18 / $199.53	Professional	50	$30.20	$83.18	$199.53
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.79 / $14.79 / $81.28	Professional	52	$14.79	$14.79	$81.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $35.48 / $79.43	Professional	TC	$21.88	$35.48	$79.43
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $154.88 / $194.98	Facility		$131.83	$154.88	$194.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $46.77 / $75.86	Professional		$33.11	$46.77	$75.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $10.72 / $16.60	Professional	26	$7.76	$10.72	$16.60
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $50.12 / $70.79 / $114.82	Professional	50	$50.12	$70.79	$114.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $35.48 / $56.23	Professional	TC	$23.99	$35.48	$56.23
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $12.59 / $40.74 / $91.20	Professional		$12.59	$40.74	$91.20
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $8.91 / $10.23	Professional	26	$7.94	$8.91	$10.23
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $32.36 / $48.98	Professional	TC	$20.89	$32.36	$48.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $114.82 / $524.81	Facility		$61.66	$114.82	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $6.46 / $30.20 / $43.65	Facility	TC	$6.46	$30.20	$43.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $39.81 / $75.86	Professional		$26.92	$39.81	$75.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $10.47 / $18.20	Professional	26	$6.61	$10.47	$18.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $28.84 / $58.88	Professional	TC	$20.42	$28.84	$58.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $43.65 / $53.70	Professional		$36.31	$43.65	$53.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $9.55 / $12.02	Professional	26	$7.76	$9.55	$12.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $34.67 / $42.66	Professional	TC	$28.18	$34.67	$42.66
Medcost Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $45.71 / $79.43	Professional		$37.15	$45.71	$79.43
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $15.49 / $17.38	Professional	26	$12.30	$15.49	$17.38
Medcost Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $44.67 / $70.79	Facility		$30.20	$44.67	$70.79
Medcost Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $34.67 / $60.26	Professional		$34.67	$34.67	$60.26
Sentara Facility/Professional Facility Modifier Low / Median / High Price $9.77 / $31.62 / $83.18	Facility		$9.77	$31.62	$83.18
Sentara Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $37.15 / $147.91	Professional		$10.72	$37.15	$147.91
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $11.22 / $19.05	Professional	26	$8.32	$11.22	$19.05
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.11 / $60.26	Professional	TC	$23.44	$33.11	$60.26
United Facility/Professional Facility Modifier Low / Median / High Price $8.51 / $28.18 / $186.21	Facility		$8.51	$28.18	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $38.02 / $66.07	Professional		$23.44	$38.02	$66.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $9.77 / $16.98	Professional	26	$6.46	$9.77	$16.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $27.54 / $48.98	Professional	TC	$17.78	$27.54	$48.98